Recent human brain imaging studies have examined differences in activity in the nucleus accumbens (N.Acc.) in response to heat stimuli between controls and patients with chronic pain, and have revealed that the N.Acc. plays a role in predicting the value of a noxious stimulus and its offset, and in the consequent changes in the motivational state. Nevertheless, the molecular mechanisms of change in the circuitry involved in emotion and motivation in response to chronic pain stimuli were not fully explored.

The principle of double effect is widely used to permit the administration of narcotics and sedatives with the intent to palliate dying patients, even though the administration of these drugs may cause hastening of death. In recent medical literature, this principle's validity has been severely criticized, causing health care providers to fear providing good palliative care. Most of the criticisms levelled at the principle of double effect arise from misconceptions about its purpose and origins.

The use of terminal sedation to control the intense discomfort of dying patients appears both to be an established practice in palliative care and to run counter to the moral and legal norm that forbids health care professionals from intentionally killing patients. This raises the worry that the requirements of established palliative care are incompatible with moral and legal opposition to euthanasia. This paper explains how the doctrine of double effect can be relied on to distinguish terminal sedation from euthanasia.

In 2000, people aged 65 and older made up 12.4 percent of the U.S. population. Between now and 2011, when the earliest-born of the baby-boom generation reaches that age, the nation will see a rapid growth in its senior citizen population. It has been estimated that pain occurs in from 45 percent to 85 percent of the geriatric population. Much of it is undertreated. Undertreated pain leads to other problems, including reduced quality of life, decreased socialization, depression, sleep disturbances, cognitive impairment, and malnutrition.

Recent statements emanating from high-level church authorities have reignited discussion over the traditional Roman Catholic doctrine guiding end-of-life care. Although these statements concerned the specific issue of artificial nutrition and hydration for patients in a persistent vegetative state, they contain principles that might be applied to other life-prolonging interventions. This paper examines the origins of the Catholic moral tradition that guides end-of-life care.

Looking back over the span of years surveyed, it appears that a sad experience, even many years ago, commonly leaves residual pain. This can be modified by sympathetic support enabling parents and baby to interact, although such interaction is not without painful as well as pleasurable effects. Coming to terms with loss may take longer than was previously thought. This study highlights the need for bereavement care, which aims to leave families with positive rather than negative feelings.

This paper explores how music therapy can assist patients and relatives in the processes of making friendship and love audible in a child cancer ward. Four short patient histories are presented to illustrate a health-oriented, ecological music therapy practice. Two histories describe how texts, made by patients, become songs, and how the songs are performed and used. Another two histories deal with musical communication with dying children and their parents.

The aim of this study was to illuminate the way of being a family when one family member is in the midst of living and dying. A family systems frame and a life world perspective were used in interviews with five families. A qualitative analysis inspired by Giorgi revealed dialectic and dynamic processes in constant motion within and between the continua being in affinity-being in loneliness, being in power-being in helplessness, and being in continuity-being in disruption.

Lullabies and laments promote new awareness, enculturation, adaptation, and grief expression. These concepts' relevance to palliative care, however, has not been examined. In this study, a music therapist used a grounded theory-informed design to reflexively analyze lullaby and lament qualities, evident in more than 20 years of personal palliative care practice. Thus, the construct "lullament" emerged, which signified helpful moments when patients' and families' personal and sociohistorical relationship with lullabies and laments were actualized.

Fifty-four thousand children die each year despite the advances in care for children with acute and chronic illnesses. Demands for improved palliative and end-of-life care for children exist. Good death is a concept frequently used in the adult hospice movement. However, how can the death of a child be good? Analysis of good death can assist pediatric nurses to understand the concept and provide a framework for nurses in the clinical and research arenas to work together to develop and provide evidence-based, developmentally appropriate care for dying children and their families.